Community-acquired pneumonia (CAP): moderate/ severe (CURB65=2-5)

Community-acquired pneumonia (CAP)

symptoms consistent with lower respiratory tract infection (i.e. fever, cough, chest pain) AND evidence of consolidation on Chest X-ray.

CURB65: Confusion (AMT 8 or less), Urea greater than 7, Resp rate 30 or more, BP less than 90 systolic or 60 or less diastolic, Age 65 years or older

Take blood cultures and appropriate samples (e.g. pus, pleural fluid) for culture
Consider further investigation for atypical pneumonia including urine for Legionella antigen
When community respiratory viruses are common, SarsCoV2, RSV and/or influenza testing is indicated
HIV AgAb testing is indicated
See also NICE NG138 (revised 2022) and NICE NG191 (revised 2023)

Treat for 3-5 days (review iv daily)

Review empirical treatment within 48 hours

Open all

amoxicillin 1g iv tds (or 500mg po tds)

+ doxycycline 100mg po bd

For non-severe and severe penicillin allergy: clarithromycin 500mg bd po or iv if unable to take po

Alternative in pregnancy for patients with penicillin allergy: erythromycin 500 mg qds po or iv

Consider Delabelling of spurious penicillin allergy in patients who are low risk and are clinically stable.

Preferred

Alternative

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